Provider Demographics
NPI:1306189600
Name:FERRETTI, MARIAN THERESA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MISS
First Name:MARIAN
Middle Name:THERESA
Last Name:FERRETTI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MS
Other - First Name:MARIAN
Other - Middle Name:THERESA
Other - Last Name:FERRETTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANP
Mailing Address - Street 1:101 MARINE AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7256
Mailing Address - Country:US
Mailing Address - Phone:718-836-3983
Mailing Address - Fax:
Practice Address - Street 1:52 MEADOWS ST
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-1912
Practice Address - Country:US
Practice Address - Phone:212-980-4294
Practice Address - Fax:212-994-3482
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302070363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health